Inspection of soft tributes after childbirth. Restoring the integrity of the generic channel

Inspection generic paths on mirrors

Inspection of the lastness of integrity

Selection of separated last exterior receptions

Purpose:selection of separated last, if it is not born independently.

Resources: Equipment of the maternity hospital urinary catheter, kick-shaped tray; disposable gloves.

Algorithm Action:

1. The abdominal method:

· Inadecitate the urine catheter;

· Front abdominal wall Capture both hands in a longitudinal fold so that both straight abdominal muscles were tightly covered with fingers;

· Invite the feminine to rebuild.

2. Generator method:

· Stand next to the guinea;

· Both hands, compressed in fists, the back surface of the FALNG Put on the bottom of the uterus in the field of pipe corners;

· Pressing the bottom of the uterus, gradually increase the strength of this pressure until the birth of the last.

3. Method of credential - Lazarevich:

· Give the uterus to the middle position;

· Make an easy outer massage of its bottom;

· Clamp uterus right hand so that thumb lay on the front surface of the uterus, and the palm on the bottom of the uterus, four other fingers place on the rear surface of the uterus;

· The movements from top to bottom appear on the uterus and achieve birth.

Purpose of the study:estimation of the status of the last.

Resources:tray, functional table, napkin, scales, centimeter tape, disposable gloves.

Algorithm Action:

1. To put on a smooth surface (tray) with the maternal side up, drain the napkin and start examining:

· From the motherboard should be all the slices, the surface must be smooth, brilliant, gray - of blue color;

· Pay attention to the edges of the placenta, on the fabric changes: the presence of occurrence, fat rebirths, old blood clots.

2. Raise the post after the umbilical cord, straighten the shells

make sure the integrity of the shells, specify the place of them

rip and discontinuity size.

3. Consistently inspect the umbilical cord, fruit

the surface of the placenta, the course of vessels, do not pass

they are on the shell and there are no additional poles.

4. Measure the placenta after inspection and weigh.

5. Data inspection to enter the history of childbirth.

Purpose: Diagnosis of postpartum injuries.

Resources: generic bed; Sterile tools: scissors, postpartum mirrors, finished clamps, needle holder, surgical needles, suture material, anatomical and surgical tweezers, kootsang; Antiseptic solution (1% iodonate solution or 2% iodine solution), sterile diaper, sterile gloves, sterile cotton swabs.

1. Explain the Children's need for this study.

2. Process the external genitals by antiseptic.

3. Sterile a sterile diaper under the buttocks of the parent.

4. From the package for childbirth take wide postpartum mirrors.

5. Sequentially enter the mirror in the vagina, exposing the cervix.

6. Pass the mirror arms assistant. Using two finished clips, starting from 12 hours, clockwise, shifting clips, inspect the edges of the cervix for detecting breaks, carefully inspect the length and beginning of the rupture.

7. Withdrawing the mirrors, inspect the walls of the vagina. When detecting a break, set its degree.

8. With the help of cotton tampons, we consistently inspect the external genitals, the rear spike, crotch.

9. If the cervical break is found, the vagina and the crotch must be embedded in compliance with the aseptics and antiseptic rules on the background of anesthesia (see the relevant standards).

Completed by a complex physiological process, in which exile from the uterus through the natural generic paths of the fetus, the last and the accumulation waters. Usually, childbirth occurs after 10 obstetric months (280 days, 39 - 40 weeks of pregnancy). By this time, the fruit becomes mature, capable of extrietic existence. Such kinds are called timely.

If childbirth occurs in terms of 28 - 29 to 37 - 38 weeks of pregnancy, they are called premature, and later 41-42 weeks - late.

Harbingers of childbirth.Birth rarely occur unexpectedly, suddenly. Usually for 2 - 3 weeks before their occurrence, a number of signs appear, which are considered to call the harbingers of labor . These include:

1) lowering the presets of the fetus to the entrance to the small pelvis. For 2 - 3 weeks before delivery, the preserving part of the fetus, most often the head, presses to the entrance to a small pelvis, as a result of this, the height of the uterus bottom is reduced. Pregnant at the same time notes that it becomes easier to breathe;

2) increasing the excitability of the uterus. In the last 2 - 3 weeks, irregular cuts in uterus occur periodically, accompanied by painful progress. Such contractions of the uterus are evaporated with false populatons, biasbingers, preparatory (liquidated) fights. False contractions never carry regular character and do not lead to changes in the cervix;

3) B. the last days before childbirth in pregnant per.ensure the mucous membralls from the sex tract, the mucosa of the plug is selected - the contents of the cervical channel, which also indicates the proximity of the onset of the generic act.

On the eve of childbirth, there are changes in the cervix, the aggregate of which characterizes the state of its maturity. These changes are easily recognized during a vaginal study and are expressed as follows: Mature cervix is \u200b\u200blocated in the center of the small pelvis, shortening (the length of the mature cervix does not exceed 2 cm) and softened; The cervical canal becomes passing for a finger.

Generic expensive forces.

The generic expensive forces include contractions and sweats. The beginning of childbirth is the emergence of regular cuts of the uterus - generic battles. Fights arise involuntarily, regardless of the desire of a woman. Generic contractions are periodic and often accompanied by painful sensations. The gaps between the fights are called pauses. Initially, the contractions alternate each silent 10 - 15 minutes and last 10 - 15 s. Subsequently, the fight is rapidly and become longer. At the end of the first period of childbirth, the fights occur every 3 - 4 minutes and last 40 - 45 s. Since the emergence of regular generic activities and yes graduation, a woman is called a guinea.

Another variety of expensive forces are sweat. In addition to cutting the uterus, the sweat includes the involvement of the muscles of the abdominal press, aperture, upper and iizhny limbs. The sweeps occur reflexively due to irritation of the nerve endings of the cervix, vagina, muscles and fascia of the pelvic floor moving along the generic channel to the preserving part of the fetus. Purchas arise involuntarily, but, unlike bouts, the female has been smears to regulate their strength and duration. This allows the doctor and midwife with special techniques to manage childbirth during the exile. As a result of the simultaneous consistent action of the contractions of the uterus and skeletal muscles, expulsion of the fetus occurs.

Clinical course of childbirth

In the clinical flow of birth, three periods are distinguished: the first period is the disclosure, the second period - exile, the third period is the last one.

Period of disclosure

The disclosure period begins the occurrence of regular generic activity - generic battles and ends with the full opening of the uterine zois. During the period of disclosure, under the influence of generic fights, the cervical neck is gradually smoothed and the uterine opens zev.This process of unequal at first and repeated women. If the first-night initially smoothes the cervix (disclosure of the internal uterine zoom), and then the disclosure of the outer mouth, then repeatedly these processes occur simultaneously. With a fully smoothed cervix, the region corresponding to the outer zev is called the accurate zev. When the uterine cavity and the owner comes to the genital channel. Matching ZEV is determined in the form of a fine narrow stretching of a border, located around the preliminary part of the fetus. The diameter of the matoching point with full discovery reaches 10 - 12 cm, with such a degree of discovery, the birth of a mature fetus is possible during the period of expulsion. In addition to generic battles in the process of opening the cervix, a fetal bubble takes part.

During the contraction, the volume of the uterus decreases, the intrauterine pressure increases, the strength of which is transmitted to the oily water. As a result, the fruit bubble is wedged into the cervical canal, contributing to the seppe smoothing of the cervix and the disclosure of the uterine. After the end of the contraction, the pressure inside the uterus decreases, the fetal bubble voltage decreases. With a new battle, everything is repeated.

With the full or almost complete disclosure of the uterine duty at the height of the fight at the maximum voltage, the fruit bubble breaks down and the front water is pouring. The rear waters usually pour along with the birth of the fetus.

The power of waters with the full or almost complete disclosure of the uterine zois is called timely, with not complete disclosure - early.

If the accumulate water is poured prior to the start of regular generic activity, it says about the preference of the belt (prenatal) of their influence. In rare cases, there is a late influence of the octoperwater. This happens in cases where the rupture of the fruit bubble and water is irrigated in the period of expulsion. Duration of the first period rodovpeivifying items range from 12 to 16 hours, in repeatedly from 8 to 10 hours.

Exile period

The second period of childbirth is the period of expulsion - it begins with the moment of complete disclosure of the uterine zone and ends with the birth of the fetus. Shortly after timely, the influence of the octic flooded waters of the contractions are enhanced, their strength and duration increases, pauses between the fights are shortened. This contributes to the rapid lowering of the preemptive part of the fetus into the cavity of the small pelvis, irritating the nerve endings of the cervix, vagina, muscles and fascia of the pelvic bottom and the reflex occurrence of the fence, under the action of which expulsion of the fetus occurs.

At the height of one of the dyg of the germ, a small portion of the preempting part of the fetus appears (most often the head). In the pauses between the attempts, it is hiding to appear to a greater extent at the next sweat. This process is called the cutting of the prerequisite part of the fetus. After some time, with the development of the generic activity, the preserving part of the fetus is moving along the generic channel and is no longer hidden in pauses between the attempts. itthey are called P.R o r e z in a n and e m of the preserving part of the fetus, itends the birth of the whole head. The born head is originally addressed by the trash, and then as a result of the inner turn of the fetal body, the head is relieved by the face of the mother's thigh opposite position of the fetus. In the future, at the height of one of the following fence, the birth of the shoulders and the whole fetus. Simultaneously with the birth of the fetus, the rear waters are poured.

The expulsion period continues from primary from 1 to 2 h, in repeated - from 20 minutes to 1 h.

Biomechanism of childbirth.

The combination of movements made by the fruit when passing through genericthe path is called biomechanism of childbirth.

The most commonly found normal is the mechanism of childbirth at front form bustle prepay. For a normal generation mechanism, the state of flexing the head over the entrance to a small pelvis is characterized, as a result of which the fetal population is turned into the entrance to the small pelvis. The fetal head of the fetus heads is usually in the transverse or slightly oblique size of the entrance plane in a small pelvis.

The mechanism of childbirth in the lead of the occipital presence.

There are 4 moments of childbirth.

First moment - fetal heads. In the entrance to a small pelvis, the head moves around the imaginary transverse axis, as a result of which the chin approaches the chest, the head is lowered into the entrance to a small pelvis, small spring is located below large. With further promotion by the generic channel, small spring should be on a wired pelvic axis, being a drive point.

The leading (wired) point is the point of the fetus, which is first lowered into the input of a small pelvis,

it follows the wired axis of the pelvis and the first is shown at birth. The flexion of the head leads to a relative decrease in the prerequisite part of the fetus. As a result, the head flexion passes all the planes of a small pelvis more freely, with its smallest, low-sized diameter of which is 9.5 cm, with a circle of 32 cm.

The second point is the inner turn of the head. The fetal head simultaneously with the progressive movement turns around the longitudinal axis. At the same time, the cooler of the fetus turns the kepenta, to the Lonnoy articulation, and the Lichiko - the Zada, to the sacrum.

The third time is the extension of the head. The extension of the head occurs at the exit of a small pelvis. The bent head reaches the pelvic bottom, the muscles and fascia of the pelvic bottom have resistance to its further advancement. As a result, the head deviates to the place of the smallest resistance - a vulvive ring, is rotating around the imaginary transverse axis, the klyaond is deflected - is inflicted.

The fourth moment is the inner turn of the shoulders and the outer turn of the head. The shoulders at the outlet of the small pelvic turn out of the transverse size in a straight line. At the beginning, the front shoulder fit, after the fixation of which the torso bends in the cervical and thoracic department, while the back shoulder is born. After birth, the body and legs of the fetus are easily born. At the time of the inner turn of the shoulders, the head turn is performed. Futher's face turns to the thigh of the mother depending on the position of the fetus: at the first position - to the right thigh, at the second position - to the left.

Last period

The third period of childbirth is the last time - begins from the moment of the birth of the fetus and ends the birth of the last. The subsequent placenta, spindle shells and umbilical cord. In the last period, under the influence of recent contractions, the placenta and shells are separated from the walls of the uterus and the birth of the last. Exile of the lane is carried out under the affecting of the fence.

After the birth of the lane, the uterus is strongly reduced, with the result that the finalization of the uterine vessels in the area of \u200b\u200bthe placental area and the stopping of bleeding occurs. With normal targets, the general blood loss does not exceed 250 ml, often it is only 50 - 100 ml. Such blood loss is considered physiological. Blood lodging from 250 to 400 ml is called border, and SVPPU 400ml - pathological.

Since the end of the lateral period, the generic process is completed and the woman is called the Ring of Tsei.

The duration of the lateral period ranges from 5 - 10 minutes to 2 hours. The total duration of physiological genera at primible is an average of 10 to 12 hours, in repeated - from 8 to 10 hours.

Observation and care for the girlfriend in the period of disclosure

The first period of childbirth is the period of disclosure - the feminine is carried out in bed in the prenatal ward, it is allowed to get up only for the purpose of water and when the caution of the pre-depicting part in the inlet in a small pelvis. Medical personnel must be unduraially in the prenatal, observe the general condition, well-being and behavior of the woman in labor in childbirth, skin Pokrov and mucous membranes, aware of the presence of headaches, vision disorder. The medical sister, the midwife must be carefully observed in the face of g and and when working in prenatal: carefully, it is sensitive to the guinea, clearly and timely carry out the appointment of a doctor, to unite confidence in the prosperous outcome of birth .

Obstetrician (medical sister), observing the general state of the feminine, every 2 h measures arterial pressure, determines the pulse, follows the body temperature 2 times a day.

During the entire period of disclosure, they are observed for the nature of the generic activity. The activity of labor activity is determined by the duration of the fight, its strength and frequency. Technically, this is performed as follows: the midwife (medical sister) puts the right hand to the front abdominal wall, striving through the abdominal wall to determine the state of the uterus. The stopwatch determines the duration of the bouts and pauses between them. The fight is felt by hand as a seal of the uterus, pause - as relaxing it.

Much attention is paid in the first period of labor control over the state of the fetus. Information about its condition is obtained while listening to the palpitations of the fetus by an obstetric stethoscope, or the Kid apparatus, as well as by registering the fetus of the fetro and fruit. At the same time, the frequency of palpitations of the fetus, rhythm and sound tones are taken into account. Normally, the frequency of palpitations of the fetus ranges from 120 to 140 beats per minute.

If the midwife ( nurse) Notes changes in the fetal heartbeat, it should immediately report this to the doctor. May change the rhythm of the fetal heartbeat, instead of constant steady rhythm begins to change, thatcutting to 90 - 100 shots per minute, then a student is up to 140 - 150 per minute. Often, the rhythm changes are combined with changes in its sonicity. The palpulation of the fetus becomes deaf or, on the contrary, overly sound. The changes in the rhythm and the dies of the fetal heartbeat are the most typical manifestations of hypoxia (oxygen deficiency) of the fetus. An additional manifestation of the hypoxia of the fetus is an increase in its motor activity, while the fever notes the rapid movement of the fetus or, on the contrary, weakened (quiet) movement. In this regard, the midwife must constantly inform the woman in labor about her sensations.

If the doctor confirms the emergence of the hypoxia of the fetus, the medical sister (obstetric) carefully performs its appointments (inhalation of oxygen, introduction to Vienna 40 ml of 40% glucose solution, 4 ml of 5% solution ascorbic acid, 100 ml of kocarboxylase, 4 ml of 1% sietyin solution), which contributes to the usually improving the state of the fetus.

An important value for the normal flow of the generic act has a function bladder. The feminine is recommended to empty the bladder every 2 - 3 hours. The bladder overflow has an unfavorable, weakening influence on generic activity. If the guinea cannot empty the urine bubble independently, resort to its catheterization. For this purpose, the external genital organs are wrapped with a solution of potassium permanganate.

With a few thoroughness, it is necessary to observe in the first period of childbirth for the intestinal function. Usually the intestine is emptied by the cleansing enema during the receipt of the guinea to the maternity hospital. Subsequently, if within 12 hours there was no defecation, they put the cleansing enema.

In order to prevent the ascending infection, the purity of the external genital organ in labor organs, every 6 hours, spend their toilet with a solution of potassium permanganate 1: 1000. In addition, the toilet of the external genital organs is carried out before the production of vaginal research, followed by changing the sterile lining diaper.

With the full opening of the uterine zoom and lowering the head of the fetus into the cavity of the small pelvis, the feminine is translated into a labor hall, where observation continues and help in childbirth in the period of expulsion.

Observation and assistance in childbirth in the period of expulsion

During the entire period of expulsion, near the woman in labor should be a doctor and midwife (medical

sister) the period of expulsion is observed for the general state of the feminine, the coloring skin and mucus of the shells, regularly follow the pulse, arterial pressure; You are aware of the well-being of the feminine, given the possibility of the appearance of a feeling of a shortage of air, headaches, vision disorder anddr. Carefully control the nature of the generic activity, determining the frequency, strength and duration of the fence, pay attention to the state of the lower uterine segment (thinning, soreness), in the s of the standing of the Control Ring.

In addition to observing the overall guide, the level of blood pressure, the rate of the pulse, the severity of labor activities, the promotion of the fetus by the generic channel, is necessary to control the state of the fetus. After each swelling, the palpitations of the fetus are determined, paying attention to its frequency, sonicity, rhythm.

Of great importance in the period of expulsion give the observation of the state of the outer genitals. Sweets of small and large sexual lips indicates the squeezing of soft tissues of the generic paths, most often with narrow pelvis. Appearance blood discharge From the genital paths indicates the beginning of a soft tissue (vagina, crotch) or a premature detachment of a normally located placenta. The leakage of the oily water, painted by Mekonia, indicates the hypoxia of the fetus, an impurity byhoplodic waters Muka - for infection of the generic pathways, etc. During the teething of the fetal head, the muscles and the fascia of the pelvic bottom are expressed in expressiveness, especially the crotch area. The fetal head in the process of teething is subjected to squeezing from the generic channel. Special techniques whose combination is called the name of the obstetric benefits in childbirth, the midwife deposits the protection of the crotch against damage and gently displays the fruit of the genital tract. The external genital feed organs, the inner surface of the hips is treated with a 5% alcoholic solution of iodine, or 1% iodonata solution, the area of \u200b\u200bthe anal hole is closed with sterile marks, under the buttocks put a sterile diaper.

An obstetric allowance in childbirth is as follows:

1. Regulation of the promotion of the flowing head. To this end, during the cutting of the head-whisher, standing to the right of the woman in labor, has a left hand on the pubic of the woman in labor, the end phalanges of the 4 fingers gently presses on the head, bending it towards the crotch and holding back her rapid birth.

The right hand of the midwife has on the perineum in such a way that the palm is in the crotch area below the rear spike, the large and 4 other fingers were located on the sides of the vulvar rings - the thumb on the right large sexual lip, 4 - on the left large sexual lip. In the pauses between the athletics of the midwife, it carries out the so-called tissue loan: clitoris fabric and small sexual lips, i.e., less stretched fabrics of a vulvar ring, led to the crotacetry exposed to the head of the head with the greatest voltage.

2. Disagreement of the head. After birth, the head of the head is the area of \u200b\u200bthe podgetynaya pits (point of fixation) suitable for the lower edge of the Lonnoye. From this time, the woman in labor is prohibited and removed from the head outside of the coup, thereby reducing the risk of perineum injury. The feminine is offered to put hands on the chest and breathe deeply, rhythmic breathing helps to overcome the fuel.

The midwife continues to hold the crotch with his right hand, and the fetus head captures the left hand and gradually, gently flexing it, drives the crotch fabric head. Thus, the forehead, face and chin of the fetus is gradually born. The born head is facing the head of the Zada, the population of Kepened, to Lon. If after the birth of the head, the cord is detected, carefully pull up and remove it from the neck through the head. If it is not possible to remove the umbilical cord, it is intersect between the Kochra claps.

3. Liberation of the brachial belt. After the birth of the head within 1 - 2, the shoulder belt is born and the whole fruit.

During the sweat, the inner turn of the shoulders and the outer turn of the head occurs. Woventers from the transverse pass into the direct size of the outlet of the pelvis, the head is rotated to the right or left thigh of the mother opposite the position of the fetus.

In the teething of the shoulders, the risk of perineum injury is almost the same as at the birth of the head, so the midwife must be careful with the crotch protection at the time of her shoulders.

In the teething of the shoulders it turns out the following help. The front shoulder is suitable for the lower edge of the Lona joint and becomes a point of support. After that, carefully reduce the crotch tissue from the back of the shoulder.

4. Disagreement of the body. After the birth of the shoulder aboutthe belt with both hands carefully capture the breasting of the fetus cell, introducing the index fingers of both hands into the sublifting depressions, and lifted the fetal torso torso and the fetal legs are born without difficulty. Born baby is put on a sterile heated diaper, a horizontal position is given by the feminine.

The first toilet of the newborn

The midwife washes his hands, processes them with alcohol and then embarks on the toilet of a newborn. The oral cavity and the nose of the newborn frees from the mucus using a sterile canister or catheter connected to an electrical suction. Then proceed to the prophylaxis of ophthalmoblennorya in Matveyev. Methodit is as follows: the eyelids of the newborn are wiped with a sterile wool (a separate ball for each eye), the left hands are carefully delayed with the lower eyelids down and, using sterile pipette, is applied to the mucous membrane (conjunct) of age 1 - 2 drops of sterile freshly prepared 2% silver nitrate solution or 30% of the albuchis solution, and girls in external genital organs.

Next, proceed to the treatment of umbilical cord. Primary treatment and dining of umbilical umbilicals are produced after the complete termination of the ripple of its vessels, which usuallyhappens after 2 - 3 minutes after the birth of the fetus. You should not cross the umbilical umbilical to stop the vascular pulsation, since during this time there are about 50 - 100 ml of blood from the vessels of umbilical cord and placenta to the fetus. Before the intersection of the umbilical umbilical branch, it is wiped with alcohol at a distance of 10 - 15 cm from the umbilical ring, then two kohler clamps are superimposed. One clamp at a distance of 8 - 10 cm from poucher ring, the second is 2 cm below the first one. The umbilical cord between the clamps is treated with 5% iodine mortar and intersect with sterile scissors, the clamp is shifted to the input level into the vagina. The newborn shows the mother and transfer to the newborn room.

In the room of a newborn child put on a changing table, covered with a sterile diaper, and produce the final treatment of umbilical cord. It consists in the following: midwife re-wash his hands with soap and processes them with alcohol. The fruit segment of the umbilical segment additionally processes alcohol, the remaining blood is squeezed out of it. At a distance of 0.5 cm from the umbilical rings on the umbilical cord with a special tool - the clamp is imposed with a corner bracket. The umbilical residue over the bracket is cut off with sterile scissors, the surface of the umbilical cord is lubricated with a 5% solution of potassium permanganate, after which the umbiliary culture is wiped with a dry sterile marlevine. The residue of the cumulative with the bracket superimposed on it is 5 - 6 h covered with a sterile napkin, and then it is removed and the residue of the umbilical cord remains open; It is carefully examined by a doctor of branches of newborns.

After applying a staple of a corner and cut-off a cord residue, the surface of the cut twice with an interval of 3-5 minutes is treated with a 96% alcohol solution.

After processing the cummination, the midwife ends the toilet of the newborn. Skin surfaces are treated with a napkin moistened with sterile vaseline or under sun oil, while removing excess of raw-like lubrication, blood remains and mucus. Having finished the toilet, the newborn carefully examines with the aim of identifying congenital abnormalities of development or damage arising sometimes in childbirth (crook fracture, shoulder bone, the formation of kefalohematomes, etc.). Then the child is weighed on children's scales, the growth is measured, the circle of the head in direct size, the circumference of the shoulders. There are signs of maturity, immaturity and sentence. On the handles wear bracelets from a medical oil and a medallion, where the name, name and patronymic of the mother, the floor of the child, its mass and growth, and the date of birth are indicated. Then the child is pelleted, they put on a sterile warm sputum, wrapped into a sterile diaper and a blanket, leave for 2 hours on a special table, after which they are transferred to the department of newborns.

Leading a leader

In the third (after-last) period of childbirth, the placenta is separated from the walls of the uterus and the birth of the last. These processes are always accompanied by blood loss, not exceeding 2550 ml (0.5% body weight) and considered physiological. In violation of the physiological flow of the recent period, pathological bleeding may occur, and therefore the female in the last period should be under the constant supervision of the doctor and midwife (medical sister).

The limit is actively expensive.

The doctor and obstetrician are observed for the general state of the feminine, the coloring skin and mucous membranes periodically measured blood pressure, the pulse is considered. For accounting and measuring blood loss under the manufacture of the manufacturer put a special flat disinfected vessel.

When conducting the initial period, it is necessary to know the signs indicating the full branch of the placenta, and to celebrate the time of their appearance.

1. Changing the shape and height of standing the bottom of the uterus is a sign of Schroedher. Immediately after birth . The fetus of the uterus has a rounded form. The bottom of it is at the level of the navel. If the full compartment of the platinum came, the uterus is pulled out in length, the bottom of it rises above the navel, the uterus becomes already, is complied and often deviates to the right of the midline.

2. The elongation of the outer segment of the umbilical cord is a sign of Alfeld. After the full branch of the placenta and shells fromthe walls of the uterus are descended into the lower uterine segment, which leads to an extension

outdoor segment of umbilical cord. The clip imposed on the umbilical umbrella at the level of the sex gap is lowered by 10 - 12 cm.

3. With the sign of Custener - Chukalov. If the full separation of the placenta came, then with the edulility, the edge of the palm of the palm of the palm tree is not drawn into the vagina. With the inseparable or incompleteness of the separated placenta of the Pupovina, on the contrary, retracts invagina.

In some cases, when the birth of the lapse is delayed with a fully separated placenta, manual techniques are used for iits discharge.

1. With p about with about b Abuladay. After emptying the bladder, a cautious massage of the uterus is produced through the front abdominal wall in order to enhance its reduction. Then with both hands capture the front abdominal wall, in the longitudinal fold. Thereafter offer a woman in labor to surprise, fully separated by the pillar withoutdifficulty is born.

Method of credential - Lazarevich. After emptying the bladder, the uterus is removed into the median pollen, carefully conduct an outer massage of the uterus to strengthen its cut. The obstecker gets up to the left of the woman in labor to her feet, the right hand captures the uterus through the front abdominal wall in such a way that four fingers are located on the back of it, the palm - at the bottom, and the thumb - on the front wall of the uterus. Then make squeezing of the last, directing the efforts of the right hand down and the shock. The separated fully separated is easily born.

Inspection of tributes after childbirth.

In order to inspect the generic paths, the purse is transported on a notch in a small operating room. The inner surface of the hips, external genital organs handle 5% alcohol solution iodine, under the buttocks of the parent's lining a sterile diaper. Doctor and midwife (nurse) wash hands, as before surgical operation. First inspect the crotch, small sex lips and the clitoris, then begin to inspect the vagina and cervix. To this end, the neck of the uterus is exposed with mirrors, fix the cervix final clips and consistently inspect the uterus throughout the circumference. When the cervical breaks are detected or the vagina is sewn. Then the mirror is removed and restored by disturbed crotch tissues and small sexual lips.

The seams line lubricate 5% of iodine alcohol. In order to the anesthesia, the local infiltration anesthesia, poufidal anesthesia, annealing of the oxygen mixture, as well as intravenous administration of Somubrevin, can be used when sewing breaks.

The first two hours after childbirth, the parental should remain in the maternity hospital under the careful observation of the doctor's duty due to the possibility of hypotonic bleeding in the early postpartum period.

All information is entered into the history of childbirth.

Inspection of soft tributes are produced in a small operating room in all primitive and repeatedly repeatedly illumination, with the help of vaginal mirrors. The parental is placed on the gynecological chair. The treatment of outdoor genital organs is carried out. disinfectant solution. Inspect the walls of the vagina and the cervix. The cervix is \u200b\u200bexposed with the help of mirrors and then captured by the ended tongs first for the front lip, then shifting them and stretching the edges, inspect it throughout every 2 cm.

Restoring the cervix with its break. Apply the single-row seam of synthetic or ketgutoy thread. The seams are superimposed by 1.5-2 cm from the edges of the rupture, through all layers of the cervix from the vagina, ranging from the upper edge of the gap towards the outer yawa of the cervix, and the first (provisional) ligature is superimposed slightly above the breakdown.

Sew the cervix usually without anneasiating. IN some cases with cervical breaks II and III degree can be used intravenous anesthesia (ketamine, etc.) or epidural anesthesia. When the cervix, the cervix III degree showed a manual examination of the walls of the uterus.

The gaps of the vagina are most often a continuation of the crotch breaks, but the isolated vaginal breaks can be observed. Therefore, the walls of the vagina should be examined even with insignificant bleeding and be sure to be sewn to the ketgut seams. Sometimes the gaps of the vagina can be deep and penetrated to the occasion-labeled and even income fiber. The sewing of such breaks is technically difficult and requires good knowledge of anatomy. With such deep gaps, hematoma may form, possibly infection.

Sewing is carried out under operating conditions when complying with all the rules of asepsis and antiseptics. The preparation of the operating field and the hands of the surgeon and assistants is carried out according to the rules adopted in surgery.

In the I and II degrees of the crotch break, the sewing is carried out more often under local infiltration or poucher anesthesia (novocaine, lidocaine), with III degree - is shown general anesthesia.

When the crotch is a degree, the ketguum seam is imposed on the top corner of the wound, the ends of the threads are captured by the clip and pull the upstairs. We impose clamps on the edges of the wound in the transition of the mucous membrane in the crotch skin. The wound is disclosed, dried with tampons and inspect. Lake-up sections of the edges of the wound are excised. Then, at a distance of 1 cm, separate ketgutic seams on the mucous membrane are applied. Moreover, the needle must be carried out under the entire wound surface, as otherwise spaces will remain where the blood interferes with healing will accumulate. The edges of the skin wound are connected by subcutaneous cosmetic seam (Ketgut, Vincle, Dexon), in rare cases - separate silk seams. The seams line is processed by iodine or iodonate.

When the crotch of the II degree is ruptured, the ketgutic seams first apply to the top angle of breaking the vaginal mucosa. Then the broken muscles of the perineum (levatoroplasty) are then combined with several separate ketguide seams. Next, the sewing is produced in the same way as with a degree break.

The method of layer-by-layer crotch wounds is also used by overlaying continuous ketguade seam. For this purpose, a chrome-plated ketgut or threads are used from synthetic absorbable material on atraumatic needles (Desson, Vincle).

Crotch wound sewing can also be made by the joke (1959) method. Sewing is made in a non-chromed ketguet. The seams are superimposed from top to bottom at a distance of 1 cm from each other. Thanks to the method of overlaying seams on the joke in the thickness of the perineum, knots are not formed and all layers come into a dense contact. When the seams are applied, the knots on the crotch disappear on their own.

Degree rupture sewing is a responsible operation requiring accurate orientation and high operational techniques, so it should be carried out by an experimental surgeon. Incidentally sew the wall of the rectum with separate synthetic seams with exciting mucous membranes and muscular layers intestine and tie ligatures in the intestine. Then change gloves, they find the ends of the ripped sphincter of the rectum and stitch them with unsessing seams. Next apply the seams in the same order as when tearing the II degree.

Resuscitation of the newborn

Resuscitation of the newborn is carried out during the asphyxia of the newborn. Apprage estimate is 1-6 points. The average degree of pulmonary depression corresponds to 4-6 points; 1-3 points - severe depression. Evaluation on the scale of apgar 0 points is regarded as stillwomen.

When assisting a newborn in the maternity hospital, it is important to comply with the sequence in the implementation of a complex of events: first, forecasting resuscitation activities and preparations for them; Secondly, restoration of passability respiratory tract, adequate breathing and cardiac activity. Then the question of application is solved medicines.

Before conducting resuscitation, the hands are thoroughly wash with soap and brush, processed by an antiseptic and put on gloves. Child is fixed. The child is carefully disappeared with a dry and warm diaper and is placed under the source of radiant heat. To ensure the passability of the respiratory tract, it can be put on the left side and lower down the head end of the table. The position on the back is often aggravated by the obstruction of the respiratory tract. Suction the contents of the rotogling, and then the nasal moves. It is necessary to avoid coarse and deep recycling of the octopling and not earlier than in 5 minutes catheterize the stomach and aspirate its contents. In case of ineffectiveness of these actions or a mixonial aspiration, the tracheal is reserved by the intubation tube under the control of direct laryngoscopy (at a permit no more than 0.1 atm). If a child after wiping and rehanging spontaneous breathing is restored, a soft tactile stimulation of heels and stop should be carried out. In the case of the preservation of the child's cyanosis, it is placed in a 100% oxygen medium at gas flow 5 ml / min.

Primary or secondary apnea, independent, but inadequate breathing is an indication for the translation of the child to artificial ventilation of the lungs.

Light ventilation Conducted with a bag or mask. You can use a self-speaking bag and a bag of anesthetic apparatus. The head of the newborn is slightly extended and the mask is imposed on face tightly, which adheres to great and index fingers And the bending of the palm of the left hand. The mask must close the chin, mouth and nose. The other fingers are the jaw of the child. The ventilation frequency is sufficient 30-50 in 1 min. When conducting the first breaths, a pressure of 30-50 cm of water column is used, then 15-20 cm is sufficiently 15-20 cm. The heart rate is restored after 15-30 seconds. When ventilating the bag, the abdomen may appear, which disappears after the introduction of the probe in the stomach.

Excursion chest and an increase in heart rate indicate the effectiveness of the events held. An independent regular breathing of a newborn allows you to estimate the heart rate (heart rate) by auscultation method of cardiac tones, palpation of the top shock or pulse on sleepy and femoral arteries. At heart rate less than 100 in 1 min. It continues to carry out IVL using a 100% oxygen mask before the Normalization of the heart rate. Restoration of cardiac activity (CSS more than 100 in 1 min) and continuing cyanosis of the skin and visible mucous membranes are an indication to carry out a 100% oxygen in oil ventilation.

The ineffectiveness of the baby ventilation using a bag or mask for 1 minute is the indication to trachea intubations .

Before intubation, the tube of the desired size is chosen depending on the mass of the body and the gestational age of the child (from 2.5 to 4.0). The endotracheal tube is cut from 13 cm with a premature child intubation. After turning on the lighting of the laryngoscope, it takes it in the left hand, holding the head of the child with his right hand. The laryngoscope blade is introduced between the language and solid sky and is moving to the base of the language. Carefully raising the blade in the direction of the laryngoscope handle, you can see the voice gap, limited by voice ligaments and the nastestrian. Endotracheal tube introduced into purph cavity from right side And at the time of opening the voice ligaments when inhaling, spending it to a mark showing the necessary depth of administration. Largeoscope, explorer and check the position of the endotracheal tube are consistently removed. It is possible to note the symmetric movements of the chest, the lack of movements and the bloating of the abdomen when inhaling, and during the auscultation of the chest - breathing on both sides. During the intubation of the trachea, the flow of oxygen is supplied to the face of the child in order to reduce hypoxia.

Indication to indirect heart massage is Heart rate less than 80 in 1 min. An indirect heart massage can be carried out with the help of index and middle fingers (or medium and unnamed) or grumping of the chest big fingers both hands. Pressing is carried out on the border of the lower and middle third of the chest with an amplitude of 1.5-2 cm and a frequency of 120 in 1 min (2 pressure per second).

The next stage of resuscitation measures is ensured by the introduction of volting preparations and medicines.

For these purposes, solutions are used:

To replenish the circulating blood deficit: 5% albumin solution, isotonic solution sodium chloride, Ringer's solution;

4% sodium bicarbonate solution;

Adrenaline solution in dilution 1: 5000.

The introduction of volting preparations and drugs is usually carried out through the catheter located in the umbilical vein. For catheterization of umbilical veins, nuclear catheters are used 3.5-4 FR or 5-6 FR (No. 6 and No. 8) with one hole at the end. The catheter is introduced by 1-2 cm below the skin level. It is better to delete it immediately after the resuscitation activities.

The testimony for drug therapy is lack of heartbeat or bradycardia (CSS less than 80 per 1 min) on the background of IVL and indirect massage Hearts for 30 seconds.

Adrenalin can be administered in order to increase the strength and frequency of cardiac abbreviations and to remove the spasm of the vessels when critical states Newborn. It is injected through the intubation tube or through the catheter, introduced into the tube, followed by washing with a solution of sodium chloride. For a more uniform distribution in lungs and sufficient absorption of adrenaline, IVL continues for some time. Adrenaline can be introduced insert into the vein of cord and repeat the introduction of the need to every 5 minutes.

Solutions for filling the BCC Used in acute blood loss or hypovolemia, which are manifested by a pallor, a weak pulse, a symptom of a pale spot for more than 3 seconds, low blood pressure and lack of effect from resuscitation activities.

The solutions are introduced into the vein of the umbilical cord at the rate of 10 ml / kg slowly for 5-10 minutes. These events allow you to fill the BCC, improve tissue exchange and thereby reduce metabolic acidosis. Normalization of the pulse, improving the color of the skin and increased blood pressure indicate the effectiveness of infusion therapy. You can repeat the infusion of one of these solutions with the persistent signs of circulatory disorders.

If a child has a bradycardia less than 80 ° C. In 1 min, and decomposed metabolic acidosis is revealed, 4% sodium bicarbonate solution (2.5 m ml of 4% of the solution) is introduced into the vein (2.5 ml / kg or 4 ml / kg of 4% solution). Usually, sodium bicarbonate solution is used in cases of severe chronic hypoxia of the fetus and a newborn only on the background successful holding IVL.

If, when conducting primary resuscitation activities within 20 minutes, the child is not restored, then resuscitation events stop.

Purpose:watch the guinea, to notice the complication timely and accept urgent measures.

Indications:

· Breaks of tributes

· Bleeding from the tributes of unclear etiology

· Swift I. fast gods

Equipment:

Sterile diaper;

Vaginal mirrors;

Corncang;

Sterile gloves;

Sterile material, napkins;

Needle holder.

Surgical needles;

Suture Material;

Scissors.

1. Explain the maternity hospital about the need for this study.

2. Local or general anesthesia.

3. Process the external genitals by antiseptic.

4. Slip the pure, sterile diaper under the buttocks.

5. From the package for childbirth, take the mirror and the lift.

6. Inspect the cervix with the help of two Corncangs, when detecting ruptures, urgent is invented.

7. As the mirrors are removed, inspection of the vagina walls, when the ruptures are detected, urgent increases.

8. When the outdoor genital breaks are broken, gauze balls are used.

9. The scene is processed by an antiseptic solution.

10.Good is carried out open and dry method.

19.Algorithm for determining the duration of bouts and pauses.

Purpose:timely diagnosis of breaches of generic activity and their treatment.

Equipment:stopwatch, Partogram.

1. Explain to the woman in labor about the need for this study.

2. It is necessary to sit on the chair to the right face to the guinea.

3. Put your hand on the belly of the woman in labor.

4. On the second arrow, determine the time of finding the uterus
In Tonus - it will be the duration of the fight, appreciate
The power of the tension of the muscles of the uterus and the reaction of the woman in labor.

5. Do not remove your hands from the abdomen, it is necessary to wait for the next contraction. The time between the fights is called a pause.

6. To give a characteristic of bouts for duration, frequency, strength, pain, it is necessary to estimate the 3-4 pumps as follows with each other. Record the frequency of the uterus in 10 minutes.

Fights duration 20 - 25 seconds after 6 - 7 minutes, rhythmic, good power, painless.

Write down graphic image The cuts of the uterus on the partograph.

On the partogram it is customary to use the following three types of hatching:

20. The following types of barrier contraceptives are distinguished:
1. Women: non-drug barrier and medication tools.
2. Men's barrier products.

Principles of action barrier contraceptives Enclosed in blocking sperm penetration into cervical mucus. Advantages of barrier methodsthe contraception is as follows: they apply and act only locally, without causing system changes; they have a small number side Effects; they are largely protected from sexually transmitted diseases; They practically do not have contraindications for use; They do not require attraction in highly qualified medical personnel.

Indications for their use:
1) Contraindications for use oral contraceptives and navy;
2) during lactation, since they do not affect the amount or the quality of milk;
3) in the first cycle of reception of oral contraceptives from the 5th day of the cycle, when the sobric activity of the ovaries is not yet completely suppressed;
3) if necessary for the reception of drugs that are not combined with OK or reduce their effectiveness;
4) after spontaneous abortion until a period favorable for a new pregnancy occurs;
5) as a temporary means before the production of sterilization of a man or a woman.

Early Pueper Period is the first 2 hours after graduating; An extremely responsible period of time during which important physiological processes of the maternal adaptation are taking place to new existence.

In the early postpartum period, an inspection of soft tributes. The nurse is processed by a disinfecting solution of external genitals, interior surfaces Hungs and assist the doctor when examining the genital tract. Inspection of the cervixes are produced using mirrors. All detected cervical breaks, vagina and outdoor genital organs, crotch are sewn, as they can be a source of bleeding and entry gates of infection for postpartum purulent-septic diseases.

The cervix, the walls of the vagina, the clitoris, large, small sexual lips are restored by ketgutov (deoxidian, vincite) seams; Crotch skin - silk seams. Sews from the crotch are shooting for 5 days.

After severe physical work and emotional tensionrelated to the generic act, the palloon is tired, sleepy. The parental has a slightly pulse, blood pressure is reduced. Body temperature is usually normal. It is possible to a single increase in temperature (not higher than 37.5 ° C) due to nervous and physical voltage.

It is necessary to closely monitor the general state of the parental, its pulse, arterial pressure, body temperature, constantly monitor the state of the uterus through the front abdominal wall, follow the degree of blood loss.

When evaluating blood loss in childbirth, the amount of blood released from the uterus in the last and early postpartum periods is taken into account. Physiological blood loss in childbirth 0.5% of body weight.

Before transferring a parental to the postpartum compartment, it is necessary:

• rate the state of the parent's (find out the complaints, assess the color of the skin, visible mucous membranes, measure blood pressure, pulse, body temperature)
• through the front abdominal wall to determine the state of the uterus: the standing height of the bottom of the uterus, its consistency, configuration, sensitivity during palpation
• determine the amount, the nature of the selection of sex tract;
• under the pelvis of the parental to substitute the vessel and offer to empty the bladder. In the absence of independent urination, release the urine catheter
• toilet exterior genital organs with a disinfecting solution by a generally accepted scheme
• in the history of childbirth general state Pedolina, body temperature, pulse, blood pressure, uterus condition, quantity, character of vaginal selection

2 hours after childbirth
row birth on a notch with newborns translated into the postpartum compartment

In the postpartum department, it is necessary to strictly observe the principle of cyclicity of filling chambers. This principle is that the godders who born during the same day are placed in one chamber. Give preference to the joint stay of the mother and the child.

The joint stay of the parental and a newborn baby in the postpartum department's chamber significantly reduced the frequency of diseases of the parents in the postpartum period and the frequency of diseases of newborn children. With a joint stay in the Chamber, the mother actively participates in the care of a newborn child, the contact of the child with the medical personnel of the obstetric department is limited, the possibility of infection with the newborn by hospital strains of conditionally pathogenic microorganisms is reduced, favorable conditions are created for the establishment of a newborn microforior organism.

The mode of operation of the postpartum separation is focused on feeding newborns. Bypassing the doctor, dressing, procedures, the treatment of therapeutic physical education are carried out in the breaks between feeding newborns.

In the postpartum branch of the maternity hospitals every day a nurse is observed:

• measures 2 times a day. Temperature of the body (in the morning and evening)
• during bypass, it turns out complaints, evaluates the condition, color of the skin and visible mucous membranes, the character of the pulse, its frequency
• give arterial pressure
• special attention is paid to the mammary glands: determines their shape, the state of the nipples, the presence of cracks on them, the presence or absence of heat
• produces palpation of the abdomen, which should be soft, painless
• determines the height of the bottom of the uterus, its configuration, consistency, the presence of pain
• daily examines the external genital organs and crotch. Draws attention to the presence of edema, hyperemia

Prevention infectious complications in the postpartum period
For the prevention of infectious complications in the postpartum period great importance It has strict observance of sanitary and epidemiological requirements and personal hygiene rules.

Much attention should be paid to the processing of outdoor genital organs. At least 4 times a day, the parental should be laughed with warm water with soap. After washing, changing the lining diapers. In the presence of seams on the crotch, they produce their processing in the dressing 2 - 3 times a day.

Toilet of the Rigor.

1. Processing the chair by dezhestor and put on it a disinfected loaf.
2. Wear a sterile mask.
3. Handle hands in one way.
4. Wear a sterile bathrobe.
5. Wear sterile gloves.
6. Prepare a sterile table with tools.
7. It is not a chair to offer a clinic.
8. Warm antiseptic solution of genitals in the following sequence: pubis, floor lips, hips, buttocks, crotch and one movement rear-ground opening from top to bottom. The irrigation fluid should be flushing down and should not fall into the vagina. Therefore, it should not be strongly spreading sex lips or vigorously wipe the processed covers with sterile cotton wool, clamped in Corncang (or loss). Do not touch the area of \u200b\u200bthe seams.
9. Drain the genitals in the same sequence.
10. Process seams with 3% hydrogen peroxide solution (96% alcohol) first in the vagina, then on the skin; dry Then to process a 5% potassium permanganate solution (1-2% alcohol solution of a diamond green or 5% iodine solution) in the same sequence.
11. Give a pherry sterile lining.
12. Suggest her to get up from the chair.

The most effective prophylactic action is provided medical agentswhich are sprayed into the seams area in the form of spray and protect the wound from the flowing loch.

In order to prevent the wound infection after the crotch injuries from the first day of Pueerperia, the maternity hospitals are shown to use physical factors: UHF - induct gear, DVM. The duration of exposure is 10 minutes daily for 6-7 days. The laser irradiation of the seams on the crotch is also used (the device "berry") daily for 5-6 days.

Evaluation of the character and quantity of loy
Lochi ( postpartum discharge) should not be abundant; their character must match the days postpartum period And have a normal smell. Lochi, flow slowly and can delay in the uterus cavity due to the slowdown in the investment process (the submissiveness of the uterus) or hitting the outflow of blood bunches. This can lead to such complications in Pueerperia as a Loci-meter, which is one of pathological mechanisms In the emergence of postpartum septic complications.

When establishing the diagnosis of the Loci-Lichiometers, a nurse with a newborn, as prescribed by a doctor is to be transferred to the observed obstetric department. Most modern method The treatment is to remove the contents of the uterine cavity under the control of hysteroscopy, preferably using an aspiration vacuum.

Involution of the uterus
The proper involution of the uterus contributes to the timely emptying of the bladder and intestines. The overflowing bladder can easily shift the ultrasound up due to the mobility of her binder apparatusthat can create a false impression of the subtletime of the uterus. Therefore, before the inspection, the parental must pur over.

With the imathine bubble atony, urination delay may occur. With the difficulty of urination, irrigating the external genital organs with warm water, assign funds cutting uterus. Good effect gives needleflexotherapy. Physiotherapy procedures can be used: UHF therapy magnetic field With the subsequent use of diadynamic currents.

When the chair is delayed on the 3rd day, a cleansing enema is prescribed or laxative. If there are seams on the crotch, these events are carried out on the 4-5th day.

The principle of active introduction of the postpartum period and early stroke contributes to the normalization of the function of the bladder, intestines, improving blood circulation, accelerating the processes of involution in the sexual system.

Postpartum gymnastics
Important importance in the process of reverse development of all organs and systems has postpartum gymnastics. Complex exercise We usually begin from the 2nd or 3rd day after delivery. Gymnastic exercises should be aimed at establishing the correct diaphragmal respiration, strengthening the muscles of the abdominal press, pelvic bottom, sphincter, the restoration of their elasticity, increase the total tone of the parental.

The use of physical exercises is dictated by the need to restore the full disability of all the authorities of the parental, which does not contribute to long-term treatment. A long lasting lying in bed leads to a violation of blood circulation, a decrease in the tone of the bladder, the intestines, which causes constipation, the retention of urination, negatively affects the involution of the genital organs and the general state of the parental.

Optimal is the early stack: 6-8 hours after childbirth. In the early rising, the well-being of a woman should take into account, compliance with the rate of pulse and body temperature.

Extract from the maternity hospital.
With a satisfactory condition, a penthouse with newborns is discharged by 5 days after childbirth.

Before the discharge of the parental from the maternity hospital, a medical sister gives her a medical certificate of birth () and a exchange card with information about childbirth (in women's consultation) and a newborn (in the children's clinic).

A conversation is held with the maternity hospital about the need to fulfill personal hygiene rules at home.

The parental must

• regularly and rationally eat;
• sleep at least 8 hours a day;
• walk with a child outdoors;
• carry out the toilet of the mammary glands, external genital organs;
• underwear change daily;
• hygienic gaskets change as pollution;
• within 2 months after childbirth, it is impossible to take a bath, it is enough to use only the shower;
• do not lift great weights;
• sex life can be resumed only after 2 months after delivery (the way contraception is selected by a woman in a precinct doctor of women's consultation)

Similarly, the patronage of newborns at home, the obstetrician-gynecologist (obstetrician) of the female consultation carries out two-time active patronage of the pants at home (for 2-3 and 7 days after the sisk), and after the operational delivery - according to the testimony. For this purpose, a telephone message in the female consultation is transmitted from the hospital, similar to the telephone program to the children's clinic.